The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Thursday, October 08, 2009

Poll shows British government hospitals are abusing sedative use on dementia patients

New research has highlighted fears of the misuse of strong sedatives in hospitals, while suggesting more than three quarters of patients with dementia receive the drugs to calm them down. In a survey of 1,100 nurses, 77 per cent reported that people with dementia on general hospital wards were prescribed antipsychotic drugs, which increase the risk of death and stroke, and can make symptoms worse. One in four said that the drugs were being used inappropriately, to sedate anxious or disruptive patients rather than give them proper treatment.

The poll by the Alzheimer’s Society comes as campaigners called on the Government to publish a review on use of the treatments, thought to be wrongly prescribed to at least 100,000 patients each year.

Last year, a report by the All-Party Parliamentary Group on Dementia concluded that proper staff training could reduce use of the drugs, improve care for patients and save money.

Neil Hunt, chief executive of the Alzheimer’s Society, said that the overprescription of the drugs was “an abuse of human rights”.

A Department of Health spokesman said last night: “People with dementia should only be offered antipsychotics if they are severely distressed or there is an immediate risk of harm.”

Today, the Senate Finance Committee is expected to vote on the mark-up of the Senate version of ObamaCare, which would create the equivalent of a public-private partnership like Fannie Mae, the Federal Reserve, or Amtrak to "compete" with private sector health insurance. And, as Woodrow Wilson opined upon the defeat of the Treaty of Versailles, "One day we shall see the tragedy of it all."

To date, the debate on ObamaCare has so closely resembled tragedies and travesties of American politics past that one cannot help but draw relevant, instructive parallels. Senator Jim DeMint (R-SC) has termed it "Fannie Med" and has cautioned that it will inevitably lead to a government takeover of the nation's health system--just like Fannie Mae and Freddie Mac led to a federal takeover of the mortgage industry, and the Federal Reserve has led to the de facto nationalization of the nation’s financial system.

In both cases, the American people were assured that these entities were sustainable and would pay for themselves. And then they did not. That they would not lead to outright nationalization of their respective industries. And then they did. And that taxpayers were not being put on the hook. And then they were. Very importantly, both have fueled meltdowns in the very mortgage and financial sectors for which they were charged with providing “stability.”

Said ALG President Bill Wilson yesterday, “Invariably, just like every other public-private ‘partnership’ started by the federal government, [the co-op system proposed] will not sustain itself and the final bill will belong with American taxpayers.” Which begs the question: why all the fuss about the Baucus plan to remove the so-called “public option” from the Senate version if the American people will wind up subsidizing “health care for all” anyway?

According to Senator Max Baucus (D-MT), Chairman of the Finance Committee, “The public option cannot pass the Senate. I could be wrong, but it's my belief that the public option cannot pass.” So Baucus, ever faithful to still vastly expanding government’s reach into the health care system—even in a slightly watered-down version—has proposed a wolf in sheep’s clothing that will inevitably feast upon the flock of private options still available on the free market. But the American people know an unfolding tragedy when they see one. And they know this one does not have a happy ending.

Americans for Limited Government estimates that the Senate bill would cost around $122 billion a year once fully implemented, or $1.2 trillion over ten years, with 26 million receiving government-subsidized health care. It will not be implemented until 2013, which really is more subterfuge to keep the bill under the $1 trillion mark.

Not that it matters that much. It still walks like a duck, swims like a duck, and quacks like a duck. It covers some 19 million less than the House’s version of ObamaCare, and may cost as much as $100 billion less per year. But, importantly, it leaves the door open for Congress to ever-expand the entitlement in subsequent years. As Ronald Reagan once said, “On this earth, the nearest thing we have to eternal life is a government program.”

Perhaps that’s why Senate Majority Leader Harry Reid (D-NV) just wants to go ahead and include the “public option” in this go-around anyway. According to the Hill, quoting the Las Vegas Sun, Reid said that “We are going to have a public option before this bill goes to the president's desk." How? Top Capitol Hill sources have suggested that Reid may simply take the language for the “public option” and amend it to an appropriations bill that has already passed the House since all funding and tax bills must “originate” in the House.

Then, depending on where the votes stand —mostly with his fellow Democrats— he would make the fateful decision to invoke “budget reconciliation”. Under that procedure, only 51 votes would be needed to pass the government-run health care proposal. The Senate filibuster —a long-standing tradition that upholds minority party rights in Congress —would effectively be eliminated as the “public option” was rammed through by the slimmest of majorities.

Finally, that bill could be sent directly to the House to be voted upon without amendment. This is the Senate-first strategy that ALG News has previously reported on. Under this scenario, Reid would never need to achieve 60 votes.

The tragedy of ObamaCare would then commence upon Barack Obama’s signature, whether or not the American people actually want it. And like Fannie Mae and Federal Reserve did to their respective industries, it will lead to disastrous consequences for the nation’s medical system. And that is “the tragedy of it all.”

A proposed requirement that all Americans carry health insurance has been met with skepticism by both Republicans and Democrats who, as the bills head to the House and Senate floor, are worried about its impact. Conservatives say that the cost of purchasing coverage would amount to a new tax on Americans, particularly those making less than $250,000, violating a campaign pledge by President Obama. Democrats are leery of passing the mandate without enough tax subsidies for low- and middle-class Americans to help them obtain coverage.

"It's a push and a pull," said Sen. Charles E. Schumer, the New York Democrat who successfully proposed amendments in the Senate Finance Committee to allow more low-income people to get out of the requirement. "You want to cover as many people but you can't make it unaffordable to people. It's going to have to be a balance."

All of the health care reform proposals working their way through Capitol Hill include the so-called "individual mandate," making it likely to be in any bill that lands on the president's desk.

The reform debate is expected to speed up as soon as the Congressional Budget Office releases its cost estimate of the Senate Finance Committee's bill, which could come as soon as Wednesday. Democrats, meanwhile, hope to use recent pledges of support from prominent Republicans as a sign that Republicans on Capitol Hill, who largely oppose the reform plans, are out of touch. On Tuesday, California Gov. Arnold Schwarzenegger voiced support for the president's reform plan, but stopped short of endorsing it. "Our principal goals, slowing the growth in costs, enhancing the quality of care delivered, improving the lives of individuals, and helping to ensure a strong economic recovery, are the same goals that the president is trying to achieve," the Republican governor said.

The statement comes after endorsements of the Democrats' plan Monday by Tommy G. Thompson, Health and Human Services secretary under President George W. Bush, and by New York Mayor Michael R. Bloomberg, an independent.

As the bills move to the House and Senate floor for what's expected to be lengthy debate, Republicans will argue that the insurance mandate is merely a new tax and isn't necessary. "It's a violation of people's freedom that want to self-insure or maybe just don't want to buy health insurance or maybe can't afford it," Sen. Charles E. Grassley of Iowa, the top Republican on the Finance Committee, has said.

Consumer Reports has decided to weigh in on the health care debate in favor of the Democratic health care proposals, or what CR euphemistically calls "health care reform." Having decided to take sides, I think it is fair to hold CR to the standards it expects of the manufacturers and service providers reviewed monthly in its flagship magazine, and on its website.

Here is the mission statement of Consumers Union, the tax-exempt parent company of Consumer Reports: "Consumers Union (CU) is an expert, independent, nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. The organization was founded in 1936 when advertising first flooded the mass media. Consumers lacked a reliable source of information they could depend on to help them distinguish hype from fact and good products from bad ones. Since then CU has filled that vacuum with a broad range of consumer information...."

Is the CR position, as laid out on its health care reform website, consistent with its mission statement? Does it provide information which empowers consumers to make a fully informed decision? And does CR present the negative as well as positive aspects of the pending health care proposals, so that consumers can distinguish hype from fact?

Unfortunately, the answer to each of these questions is that CR has not lived up to its own standards. The presentation on the CR health reform website is completely one-sided and presents only the best case scenario as to health care reform proposals on the table. As discussed below, CR's presentation is partisan, and potentially misleading, in numerous material respects. CR's presentation is what one would expect from an advocacy group with a political axe to grind, not the heretofore non-partisan name in consumer protection.

CR's Public Option Poll Is Misleading

The CR health reform website has a link at the top of the left sidebar -- the spot any blogger knows to be prime viewing territory -- which states "Most support a public plan." That statement sets the tone for the website, and CR's position. Clicking on that link leads to an April 2009 poll which CR says shows "66 percent of Americans support having the option of a public health insurance plan as part of health care reform." CR then follows with the following statement: "This new poll confirms what has been on the minds of many Americans for years - people are sick of our broken health care system that is too expensive and doesn’t cover everybody,” said Jim Guest, president of Consumers Union. “This is the year to change our system and create a fair marketplace, including the option of a public plan, where people can have affordable and quality health care choices.”

But the survey at the heart of CR's position was taken several months before there were any concrete Democratic proposals on the table. House Bill HR3200 was not issued until July, and we still are trying to find out what the full Senate will propose. CR does not note that in the intervening months since its April survey, other polls have shown widespread dissatisfaction with the Democratic proposals. Rasmussen most recently listed support for Democratic proposals at just 41%.

Additionally, and significantly, the question asked by CR as to the public plan was highly, highly misleading because it was prefaced by a pro-public plan explanation given to the question respondent (fyi, this question appears at page 10 of the full survey report). Here is how the preface and question were phrased: "Congress is discussing several ideas to address healthcare reform. One proposal provides everyone, whether insured or uninsured, an additional choice: the option of a public health plan that people can count on to cover what they need at more affordable rates. This option would allow people with good insurance that they like to keep it. Those without good insurance can gain access to reliable healthcare, regardless of preexisting medical conditions, and obtain a consistent menu of benefits. This public plan would be paid for by enrollees. Those that cannot afford to pay the full premiums would be subsidized based on their income. Please rate your level of support for this proposal. Would you say you..."

Given this preface, which seeks to portray a public option in the most positive light possible, without a hint of problem, it is not surprising that a majority of respondents responded favorably. Using such loaded pro-public option questions unfortunately is a common tactic by supporters of a public option.

But as CR surely knows, there are real disputes as to whether the introduction of a public option would result in employers dropping coverage and paying the health care tax instead, and whether it is realistic to expect that a public plan can be covered by premiums. Had the question been asked in a more neutral manner, and included possible negative consequences such as loss of existing coverage, the response likely would have reflected current polling which shows a majority against Democratic proposals.

Equally important, no place on the CR health reform website (that I could find) are the possible negative consequences of a public option, such as dropped coverage, discussed. (I did find this document elsewhere on the CR website in which CR tries to respond to some criticisms of the public option, but the document is not linked on the health reform website, and in any event, addresses the issue of dropped coverage only in passing at page 5.) Fear of losing existing provided coverage is a concern shared by 63% of the population, but warrants hardly any mention on the CR health reform website.

So the heart of CR's policy position on health care reform, the public's supposed support for a public option, is at best questionable, and at worst misleading. And the entire presentation lacks any semblance of balance, thereby depriving CR readers of the opportunity to weigh competing views.

Were this a position paper by a Democratic advocacy group, such lack of balance might be acceptable. But CR holds itself out as an advocate for providing consumers with information as to the good and bad aspects of products. Unfortunately, CR has exempted Democratic health care reform proposals from CR's usual analytical standards.

In President Obama's Washington, medical specialists are slightly more popular than the H1N1 virus. Compared to bread-and-butter primary care doctors, specialists cost more to train and make more use of expensive procedures and technology—and therefore cost the government more money. Even so, the quiet war Democrats are waging on specialists is astonishing.

From Senate Finance Chairman Max Baucus's health-care bill to changes the Administration is pushing in Medicare, Democrats are systematically attacking specific medical fields like cardiology and oncology. With almost no scrutiny, they're trying to engineer a "cheaper" system so that government can afford to buy health care for all—even if the price is fewer and less innovative ways of extending and improving lives.

Take a provision in the Baucus bill that would punish any physician whose "resource use" is considered too high. Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program —and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above. In practice, this rule will only apply to specialists.

Since there will always be a missing chair when the music stops, every year one of 10 physicians will be punished if he orders too many tests, performs too many procedures or prescribes too many drugs —whether or not the treatments result in better patient outcomes. The 5% fine is substantial given that Medicare's price controls already pay only 83 cents on the private dollar.

In Medicare, meanwhile, the Administration is using regulation to change how doctors are paid to benefit general practitioners, internists and family physicians. In next year's fee schedule, they'll see higher payments on the order of 6% to 8%. The loose consensus is that the U.S. does have too few primary care doctors —less than 5% of medical students are entering the field— in part because they're underpaid.

Fair enough. But this boost for GPs comes at the expense of certain specialties. The 2010 rules, which will be finalized next month, visit an 11% overall cut on cardiology and 19% on radiation oncology. They're targets only because of cost: Two-thirds of morbidity or mortality among Medicare patients owes to cancer or heart disease.

The way Medicare works is that Congress decides each year how much it wants to spend on doctors, period. If one area of medicine receives a larger slice of this pie, another must accept a smaller one. The portion sizes are determined using a formula known as Relative Value Units, or RVUs. Medicare assigns an RVU to each of 7,500 billable services —in 2008, a colonoscopy earned 5.64 of these units, a hip replacement 37.66. Then it multiplies a doctor's total RVUs by some dollar factor, currently about $36, and cuts a check.

The chunks Team Obama took out of cardiology RVUs are especially drastic. The basic tools of heart specialists —echocardiograms (stress tests) and catheterizations— are slashed by 42% and 24%, respectively. Jack Lewin, who heads the American College of Cardiology, said in an interview that the crackdown will cause "a horrible disruption" that will force many community and independent practices to close their doors, lay off staff or make senior patients wait days or weeks for tests and services.

Cancer doctors get hit because the Administration believes specialists order too many MRIs and CT scans. Certain kinds of diagnostic imaging lose 24% under new assumptions that machines are in use 90% of the time, up from 50%. There isn't a radiologist in America running an MRI 10.8 hours out of 12, unless he's lining up patients on a conveyor belt. But claiming scanners are used far more often than they really are lets the Administration "score" spending cuts.

And this change is applied to all expensive equipment, not just MRIs and CTs, so payments for antitumor radiation therapy will fall by up to 44%. The American Society for Radiation Oncology says it "will have a devastating effect on cancer patients' access to care."

One priority of the Baucus bill is to require the executive branch to wreak this kind of devastation every year, not just when a Democrat is President. It directs the Secretary of Health and Human Services to search out "potentially misvalued" RVUs, meaning those "for which there has been the fastest growth" or "that have experienced substantial changes in practice expenses." In other words, any specialty that grows too much must be targeted.

It's important to understand that these are "cuts" that don't actually cut any spending; the RVUs merely redistribute it from one medical bucket to another. In this case, Team Obama is sending a message to the medical community about its political priorities. The fee schedule is designed to avoid wild year-over-year payment swings, but HHS justified its decision with a flimsy survey whose data it won't release and whose results can't be replicated. Dr. Lewin told us that both HHS Secretary Kathleen Sebelius and budget director Peter Orszag refuse to meet with him to discuss the topic.

We have nothing against primary care physicians, and clearly the country could use more of them. But then, it could probably use a lot more doctors, including specialists, as the boomers age and the prevalence of obesity, diabetes and other chronic diseases rises. The increase in specialists has tracked advances over 50 years in medical science and technology. Democrats look at these advancements and see only the costs, not the benefits.

Markets are supposed to determine the composition of the workforce, not a command medical economy run out of Washington. It is perfectly insane to support one type of doctor by punishing others on a flawed theory about cost-control. The press passes all this off as routine when it bothers to notice, but we suspect our media colleagues would show more interest if Messrs. Obama and Baucus were deciding how much journalists should be paid and what they should cover.

If Democrats are going to stomp on specialists, they should at least be open about it. Then again, all Americans might take a different view of health-care "reform" if they understood that it means snuffing out the best medicine.

Patient Dumping at Mrs. Obama's Southside Chicago, The Home of Corruption

Can America look forward to this becoming a national practice under Obamacare?

Patient Dumping is the practice of dumping those that cannot afford medical services or those that would burden the system onto other medical care providers. At the University of Chicago Medical Center, patient dumping appears to be a routine practice.

In 2002, Michelle Obama became the Executive Director for Community Affairs at UCMC. Interestingly, Susan Sher, who hired Michelle for the UCMC gig, currently serves as Michelle Obama's chief of staff at the White House. Shortly after Barack Obama was elected to the U.S. Senate in 2004, Michelle received a promotion to become the Vice President for Community and External Affairs. Also serving on the board during this time was Valerie Jarrett, a senior advisor to the Obama administration.

In this new position, one of Michelle's top priorities was to solve a problem of too many poor patients or those on Medicare and Medicaid clogging the emergency room at UCMC. To deal with this problem, Michelle helped create the Southside Health Collaborative. This project served to provide a way to shuttle away patients to other medical clinics to receive care. This was blatant patient dumping.

As the program grew, Southside Health Collaborative eventually changed its name to the Urban Health Initiative. After hiring David Axelrod's public relations firm, the name was changed again.

Now we arrive in 2009. Congressman Bobby Rush (D-IL) who represents the district where UCMC is located, sent a letter requesting an investigation into the apparent acts of Patient Dumping to Congressman Edolphus Towns. Mr. Towns is the Committee Chairman of the Committee on Oversight and Reform, the committee that Mr. Rush requested to look into this matter. The letter from Mr. Rush, dated May 25, 2009, has apparently gone unanswered. We have attempted to reach Mr. Towns' office but our message has gone unanswered.

The actors in this Patient Dumping scheme are the same actors designing the new Health Care system. These types of matters must be addressed before this debate is allowed to go any further. As bloggers, we can get to the bottom of this and it is our duty to start asking some tough questions.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here